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Article: Cerebral motor cortical mapping: Awake procedure is preferable to general anaesthesia

TitleCerebral motor cortical mapping: Awake procedure is preferable to general anaesthesia
Authors
KeywordsAwake
General Anaesthesia
Motor Cortical Mapping
Issue Date2010
PublisherWiley-Blackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/ASH
Citation
Surgical Practice, 2010, v. 14 n. 1, p. 12-18 How to Cite?
AbstractObjective: To investigate the outcome of surgical resection of cerebral lesions near or at the motor cortex under general anaesthesia or in the awake condition. Methods: Patients undergoing motor cortical mapping for tumour surgery were recruited. Surgery was carried out according to the cortical mapping protocol of the centre. Tumour location, stimulation threshold, extent of resection and postoperative complications, including neurological deficits and seizure, were recorded. Results were categorized in the awake group and in the general anaesthesia (GA) group for analysis. Results: From February 2003 to July 2006, 28 patients suffering from brain tumour (24 glioma, two metastasis and two cavernoma) were indicated for motor cortical mapping to facilitate safe tumour removal.Eight patients were in the GA group. Five tumours were subcortical lesions, whereas three were cortical lesions. There were 20 patients in the awake group. Three tumours were subcortical, whereas 17 were cortical lesions. The mean stimulation threshold was 10.75 mA (5-16 mA) in the GA group and 7.7 mA (4-12 mA) in the awake group. There were four early postoperative seizures, two transient (3-month) deficits and four permanent deficits in the GA group. One early postoperative seizure, five transient deficits and no permanent deficits were recorded in the awake group. All the permanent deficits were associated with subcortical tumours and were in the GA group. Seventy five percent of the patients achieved radiological total removal and an average extent of resection of 94.15% was achieved in the awake group. Only 37.5% of patients achieved radiological total removal and the average of extent of resection was 64.1% in the GA group. Conclusions: General anaesthesia was associated with high postoperative permanent deficit despite the effort of motor cortical mapping. Higher rate of early postoperative seizure was also found in the GA group. Awake motor cortical mapping was safer and was associated with fewer complications. We suggest that awake motor cortical mapping is preferable to the general anaesthetic technique. © 2010 The Authors. Journal compilation © 2010 College of Surgeons of Hong Kong.
Persistent Identifierhttp://hdl.handle.net/10722/150916
ISSN
2013 Impact Factor: 0.172
2015 SCImago Journal Rankings: 0.121
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChan, DTen_US
dc.contributor.authorKan, PKen_US
dc.contributor.authorLam, JMen_US
dc.contributor.authorZhu, XLen_US
dc.contributor.authorChan, YLen_US
dc.contributor.authorMak, HKFen_US
dc.contributor.authorWong, TYYen_US
dc.contributor.authorPoon, WSen_US
dc.date.accessioned2012-06-26T06:14:24Z-
dc.date.available2012-06-26T06:14:24Z-
dc.date.issued2010en_US
dc.identifier.citationSurgical Practice, 2010, v. 14 n. 1, p. 12-18en_US
dc.identifier.issn1744-1625en_US
dc.identifier.urihttp://hdl.handle.net/10722/150916-
dc.description.abstractObjective: To investigate the outcome of surgical resection of cerebral lesions near or at the motor cortex under general anaesthesia or in the awake condition. Methods: Patients undergoing motor cortical mapping for tumour surgery were recruited. Surgery was carried out according to the cortical mapping protocol of the centre. Tumour location, stimulation threshold, extent of resection and postoperative complications, including neurological deficits and seizure, were recorded. Results were categorized in the awake group and in the general anaesthesia (GA) group for analysis. Results: From February 2003 to July 2006, 28 patients suffering from brain tumour (24 glioma, two metastasis and two cavernoma) were indicated for motor cortical mapping to facilitate safe tumour removal.Eight patients were in the GA group. Five tumours were subcortical lesions, whereas three were cortical lesions. There were 20 patients in the awake group. Three tumours were subcortical, whereas 17 were cortical lesions. The mean stimulation threshold was 10.75 mA (5-16 mA) in the GA group and 7.7 mA (4-12 mA) in the awake group. There were four early postoperative seizures, two transient (3-month) deficits and four permanent deficits in the GA group. One early postoperative seizure, five transient deficits and no permanent deficits were recorded in the awake group. All the permanent deficits were associated with subcortical tumours and were in the GA group. Seventy five percent of the patients achieved radiological total removal and an average extent of resection of 94.15% was achieved in the awake group. Only 37.5% of patients achieved radiological total removal and the average of extent of resection was 64.1% in the GA group. Conclusions: General anaesthesia was associated with high postoperative permanent deficit despite the effort of motor cortical mapping. Higher rate of early postoperative seizure was also found in the GA group. Awake motor cortical mapping was safer and was associated with fewer complications. We suggest that awake motor cortical mapping is preferable to the general anaesthetic technique. © 2010 The Authors. Journal compilation © 2010 College of Surgeons of Hong Kong.en_US
dc.languageengen_US
dc.publisherWiley-Blackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/ASHen_US
dc.relation.ispartofSurgical Practiceen_US
dc.subjectAwakeen_US
dc.subjectGeneral Anaesthesiaen_US
dc.subjectMotor Cortical Mappingen_US
dc.titleCerebral motor cortical mapping: Awake procedure is preferable to general anaesthesiaen_US
dc.typeArticleen_US
dc.identifier.emailMak, HKF:makkf@hkucc.hku.hken_US
dc.identifier.authorityMak, HKF=rp00533en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1111/j.1744-1633.2010.00479.xen_US
dc.identifier.scopuseid_2-s2.0-75249104356en_US
dc.identifier.hkuros178830-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-75249104356&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume14en_US
dc.identifier.issue1en_US
dc.identifier.spage12en_US
dc.identifier.epage18en_US
dc.identifier.isiWOS:000273991200004-
dc.publisher.placeAustraliaen_US
dc.identifier.scopusauthoridChan, DT=7402216549en_US
dc.identifier.scopusauthoridKan, PK=35334648400en_US
dc.identifier.scopusauthoridLam, JM=26646652200en_US
dc.identifier.scopusauthoridZhu, XL=8588524900en_US
dc.identifier.scopusauthoridChan, YL=7403676345en_US
dc.identifier.scopusauthoridMak, HKF=7004699149en_US
dc.identifier.scopusauthoridWong, TYY=35335629000en_US
dc.identifier.scopusauthoridPoon, WS=7103025507en_US
dc.identifier.citeulike6744347-

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